Provider Demographics
NPI:1306404934
Name:LOPEZ RODRIGUEZ, LAURA I (LMT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LOPEZ RODRIGUEZ
Suffix:I
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:8409 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2420
Mailing Address - Country:US
Mailing Address - Phone:240-601-4771
Mailing Address - Fax:
Practice Address - Street 1:3701 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-4556
Practice Address - Country:US
Practice Address - Phone:240-601-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04890225700000X
VA0019011796225700000X
DCMT2167225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0019011796OtherBOARD OF NURSING
DCMT2167OtherBOARD OF MASSAGE
MDM04890OtherBOARD OF CHIROPRACTORS